Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis.

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  • Additional Information
    • Affiliation:
      Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, NG5 1PB, Nottingham, UK
      Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, NG7 2UH, Nottingham, UK
      Arthritis Research UK Pain Centre, Nottingham City Hospital, NG5 1PB, Nottingham, UK
      Nottingham University Hospitals NHS Trust, Queen's Medical Centre, NG7 2UH, Nottingham, UK
      Colin Fuller Consultancy Ltd, LE12 5PE, Sutton Bonington, UK
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Background: The long-term risk from knee intra-articular (KIA) injections in professional athletes such as ex-footballers remains unknown. The use of KIA injections is controversial and remains anecdotally prolific as it is perceived as being safe/beneficial. The aim of this study was to determine the number, type and frequency KIA injections administered to retired professional footballers during their playing careers and the associations with post-career knee osteoarthritis (KOA). Methods: This is a cross-sectional study involving a postal questionnaire (n = 1207) and subsequent knee radiographs in a random sample of questionnaire responders (n = 470). Footballers self-reported in the questionnaire whether they had received KIA injections and the estimated total number over the course of their playing career. Participant characteristics and football career-related details were also recorded. KOA was measured as self-reported knee pain (KP), total knee replacement (TKR) and radiographic KOA (RKOA). Results: 44.5% of footballers had received at least one KIA injection (mean: 7.5; SD ± 11.2) during their professional career. 71% of knee injections were cortisone/corticosteroid based. Multivariate logistic regression, adjusting for age, body mass index (BMI) and significant knee injury identified that footballers with injections were two times more likely to have KP (OR 1.81, 95% CI 1.40–2.34) and TKR (OR 2.21, 95% CI 1.43–3.42) than those without injections. However, there was no association with RKOA (OR 1.30, 95% CI 0.85–2.01). Given, the association with KP and TKR, we found a significant dose–response relationship as the more injections a player received (by dose–response groups), the greater the risk of KP and TKR outcomes after adjustment for knee injury and other confounders (p for trend < 0.01). Conclusion: On average, 8 KIA injections were given to the ex-footballers during their professional career. The most commonly administered injections were cortisone based. These injections associated with KP and TKR after they retired. The associations are independent of knee injuries and are dose dependent. The study suggests that there may have been excessive use of KIA injections to expedite return to play and this contributed to detrimental long-term outcomes such as KP and TKR post-retirement from professional football.
    • Journal Subset:
      Allied Health; Australia & New Zealand; Peer Reviewed
    • ISSN:
      0112-1642
    • MEDLINE Info:
      NLM UID: 8412297
    • Publication Date:
      20200410
    • Publication Date:
      20200422
    • DOI:
      http://dx.doi.org/10.1007/s40279-019-01255-x
    • Accession Number:
      142631749
  • Citations
    • ABNT:
      FERNANDES, G. S. et al. Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis. Sports Medicine, [s. l.], v. 50, n. 5, p. 1039–1046, 2020. DOI 10.1007/s40279-019-01255-x. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=142631749. Acesso em: 24 set. 2020.
    • AMA:
      Fernandes GS, Parekh SM, Moses JP, et al. Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis. Sports Medicine. 2020;50(5):1039-1046. doi:10.1007/s40279-019-01255-x
    • APA:
      Fernandes, G. S., Parekh, S. M., Moses, J. P., Fuller, C. W., Scammell, B. E., Batt, M. E., Zhang, W., & Doherty, M. (2020). Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis. Sports Medicine, 50(5), 1039–1046. https://doi.org/10.1007/s40279-019-01255-x
    • Chicago/Turabian: Author-Date:
      Fernandes, Gwen S., Sanjay M. Parekh, Jonathan P. Moses, Colin W. Fuller, Brigitte E. Scammell, Mark E. Batt, Weiya Zhang, and Michael Doherty. 2020. “Intra-Articular Injection Administration in UK Ex-Professional Footballers During Their Playing Careers and the Association with Post-Career Knee Osteoarthritis.” Sports Medicine 50 (5): 1039–46. doi:10.1007/s40279-019-01255-x.
    • Harvard:
      Fernandes, G. S. et al. (2020) ‘Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis’, Sports Medicine, 50(5), pp. 1039–1046. doi: 10.1007/s40279-019-01255-x.
    • Harvard: Australian:
      Fernandes, GS, Parekh, SM, Moses, JP, Fuller, CW, Scammell, BE, Batt, ME, Zhang, W & Doherty, M 2020, ‘Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis’, Sports Medicine, vol. 50, no. 5, pp. 1039–1046, viewed 24 September 2020, .
    • MLA:
      Fernandes, Gwen S., et al. “Intra-Articular Injection Administration in UK Ex-Professional Footballers During Their Playing Careers and the Association with Post-Career Knee Osteoarthritis.” Sports Medicine, vol. 50, no. 5, May 2020, pp. 1039–1046. EBSCOhost, doi:10.1007/s40279-019-01255-x.
    • Chicago/Turabian: Humanities:
      Fernandes, Gwen S., Sanjay M. Parekh, Jonathan P. Moses, Colin W. Fuller, Brigitte E. Scammell, Mark E. Batt, Weiya Zhang, and Michael Doherty. “Intra-Articular Injection Administration in UK Ex-Professional Footballers During Their Playing Careers and the Association with Post-Career Knee Osteoarthritis.” Sports Medicine 50, no. 5 (May 2020): 1039–46. doi:10.1007/s40279-019-01255-x.
    • Vancouver/ICMJE:
      Fernandes GS, Parekh SM, Moses JP, Fuller CW, Scammell BE, Batt ME, et al. Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis. Sports Medicine [Internet]. 2020 May [cited 2020 Sep 24];50(5):1039–46. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=142631749